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PTSD - Post Traumatic Stress Disorder

	This is a brief description and listing of some symptoms
Links to PTSD related sites are located at the bottom of page

History and Definitions of PTSD

GENERAL

Since you are reading this, one of the followings things is probably taking place:

a. You think you may have Post Traumatic Stress Disorder (PTSD).

b. You are being treated for PTSD.

c. You know someone who has PTSD.

Before you begin this journey you need to know what Post Traumatic Stress Disorder (PTSD) is.

Less than a year ago I did not know what PTSD was and I believed that Veterans who claimed to have PTSD were using their claims to shield them from the consequences of their own stupidity or alcohol/drug abuse. Boy was I wrong.

I will try to present a brief history of PTSD and define PTSD in language you can understand so that;

a. You can determine whether or not you may be afflicted with PTSD.

b. When the time comes you will be better equipped to express your symptoms to your doctor, justify your claim in your stress letter, and explain your condition to your interviewer.

HISTORY

Prior to the studies done on Vietnam veterans, there were very few scientific studies of what we today call Post Traumatic Stress Disorder (PTSD).

The 1800’s. During the early 1800’s military doctors began diagnosing soldiers with "exhaustion" following the stress of battle. This "exhaustion" was characterized by mental shutdown due to individual or group trauma. Like today, soldiers during the 1800’s were not supposed to be afraid or show any fear in the heat of battle. The only treatment for this "exhaustion" was to bring the afflicted soldiers to the rear for a while then send them back into battle. Through extreme and often repeated stress, the soldiers became fatigued as a part of their body’s natural shock reaction.

During that time, in England, there was a syndrome know as "railway spine" or "railway hysteria" that bore a remarkable resemblance to what we call PTSD today, exhibited by people who had been in the catastrophic railway accidents of the period. In 1876 DR. Mendez DaCosta published a paper diagnosing Civil War combat veterans with "Soldiers Heart": The symptoms included startle responses, hyper-vigilance, and heart arrhythmia’s.

The 1900’s. During WWI overwhelming mental fatigue was diagnosed as "soldier’s heart" and "the effort syndrome". An article published on a now restricted Internet web site maintained by Med. Access entitled "Chronic Fatigue Syndrome" states that "...some 60,000 of the British forces were diagnosed with the problem and 44,000 of these were retired from the military because they could no longer function in combat". (www.medaccess.com/cfs/cfs_02.htm (this page is no longer accessible without a password))

The term "shell shock" emerged during WWI followed in WWII by the term "combat fatigue." These terms were used to describe those veterans who exhibited stress and anxiety as the result of combat trauma. The official designation of "Post Traumatic Stress Disorder" did not come about until 1980 when the Third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was published.

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The Diagnostic and Statistical Manual of Mental Disorders (DSM). This "bible", published by the American Psychiatric Association (APA) provides the "official" definition of all mental illnesses. When first published in 1952 what we now know as PTSD was called "stress response syndrome" and was caused by "gross stress reaction".

In the second edition (DSM-II), 1968, trauma-related disorders were lumped together in an area called "situational disorders". Mrs. Patience Mason, author of Recovering From The War: A woman’s Guide to Helping Your Vietnam Veteran, Your Family, And Yourself, points out that those Vietnam Veterans treated for the disorder during that period were informed that if their symptoms lasted more than 6 months after their return from Vietnam they had a "pre-existing" condition, making it a "transient situational disorder", and the problem was not service connected. This resulted in a lot of "walking wounded" and I am certain attributed to the high suicide rate suffered by Vietnam Veterans of that time.

Finally, in the third edition, 1980, DSM-III the title "Post-traumatic Stress disorder" was used and placed under a sub-category of "anxiety disorders". In the current edition, 1994, DSM-IV, "Post-traumatic Stress Disorder" is again used but has been placed under a new "stress response" category and remains in the "anxiety disorder" category.

You may have noticed above that what started out as a "syndrome" turned into a "disorder". According to Taber’s Cyclopedic Medical Dictionary a "syndrome" is "a group of signs and symptoms that collectively characterize or indicate a particular disease or abnormal condition" and a "disorder" is an illness. PTSD changed from being part of a collective indicator to a singular illness, a significant medical distinction.

With few exceptions, up until DSM-IV, most combat veterans were diagnosed with "shell shock", which didn’t warrant long term treatment. Other combat veterans were merely diagnosed with "bad nerves" which not only didn’t warrant long term treatment, but also induced a "get over it" attitude from the military and medical communities. This type attitude was personified in the movie "Patton" when General Patton, played by George C. Scott, threatened apparently uninjured military hospital patients with malingering.

The initial definition of PTSD described a psychological condition experienced by a person who had faced a traumatic event which caused a catastrophic stressor outside the range of usual human experience (an event such as war, torture, rape, or natural disaster). This definition separated PTSD stressors from the "ordinary stressors" that were characterized in DSM-III as "Adjustment Disorders", such as divorce, failure, rejection and financial problems.

DEFINITIONS

American Psychiatric Definition. The following is a quote, references to children excluded, from The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Washington, DC, American Psychiatric Association, 1994, section 309.81, beginning on page 427. All supplemental information, in parenthesis and bold, is from The Post-Traumatic Gazette, edited by Mrs. Patience Mason:

This disorder is described as occurring when:

"A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self (i.e. combat, friendly fire, being mortared or rocketed, wounded, captured, driving a truck on a mined road, flying in a helicopter that was shot at, jumping our of a helicopter into a hot LT) or others (if you had a buddy who was wounded or lost squad members, family member, or seeing anyone who has recently been killed or injured such as being a medic or nurse on a trauma ward, body bagging, seeing someone you didn’t know killed, seeing kids, women or other Americans or civilians who had been killed, or wounded, etc.)

(2) the person's response involved intense fear, helplessness or horror."               Back to Top

According to the DSM-IV, " B. The traumatic event is persistently reexperinced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, or perceptions.

(2) recurrent distressing dreams of the event.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and dissociative flashback episodes, including those that occur on awakening or when intoxicated).

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three (or more) of the following:

(1) efforts to avoid thoughts, feelings or conversations associated with the trauma (If you try not to think about the war or if you try not to feel love because you lost a beloved buddy, try never to feel guilt because you think you fucked up over there, try never to be happy because you were ambushed when you were feeling fine, trying never to get angry because you’re afraid of what you might do)

(2) efforts to avoid activities, places, or people that arouse recollections of the trauma (never watch war movies, don’t hunt, don’t go to veterans day parades or associate with other vets, can’t stand authority figures because of the REMF’s or the lifers, etc.)

(3) inability to recall an important aspect of the trauma (particular battles or periods of time that you can’t remember or whether those guys were killed or just wounded)

(4) markedly diminished interest or participation in significant activities (what did you used to do that you don’t since your PTSD came on? Lots of guys with PTSD stay home watching TV which is this symptom. Others still get out but they’ve given up hunting, or going places where there are crowds or whatever)

(5) feelings of detachment or estrangement from others (No one can understand what it’s like. I’m on the outside looking in at all these people who haven’t a clue. I don’t care about things or people the way I used to)

(6) restricted range of affect (e.g., unable to have loving feelings) (unable to cry when parent dies or kid dies, told you have no feelings, can’t feel love for wife, etc.)

(7) sense of a foreshortened future (e.g., does not expect to have a career, marriage, children, or even a long life span)." (may be still driving drunk or stoned, still jumping out of airplanes or taking other risks, afraid to commit to anyone or anything, etc.)

Persistent symptoms of increased arousal (not present before the trauma), as
indicated by two (or more) of the following:

(1) difficulty falling or staying asleep;

(2) irritability or outbursts of anger;

(3) difficulty concentrating (Read a page and can’t remember it? Forget what your wife just told you or constantly hear "I told you that yesterday!" Feel dumb because you don’t follow a lot of conversations, etc., or just can’t focus because part of you is scanning for danger all the time?)

(4) hypervigilance (always looking for danger, worrying about people getting hurt, still looking for tripwires and sitting with your back to the wall, avoiding crowds, etc.)

(5) exaggerated startle response (hit the dirt at the sound of a backfire, can’t be touched when asleep, etc.)

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than 1 month.

F. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

above info is from excerpts from The PTSD Manual

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